Sex After Menopause?

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I am 64 years old, and I am finished with menopause. I took estrogen for several years and stopped taking it two years ago. Since then, I have very little desire for sex. My husband and I have tried to have sex and it was terribly painful; I could not stand it. I have used lots of over-the-counter products and none have helped. My doctor says there is nothing that can be done because of the atrophy after menopause. Is this true? It feels like there's some sort of blockage, but my doctor says nothing is there. Help!

— Pauline, Kentucky

It sounds like you are having a lot of vaginal atrophy and symptoms that could be relieved with some type of local estrogen therapy. However, I don't want to encourage you to go back on hormone therapy (oral estrogen or a patch), given your age.

The first thing I'd recommend is that you try a nonhormonal lubricant, such as Astroglide or K-Y Jelly. It's worth trying this route the next time you have sex with your husband, as it may help with some of the discomfort and pain.

If that doesn't work, you may want to try a topical vaginal estrogen or an estrogen ring. There are many different vaginal creams out there, so explore the options with your doctor. Some patients prefer the ring to the topical cream, since it's less messy, but one isn't necessarily better than the other. Vaginal estrogen won't give you the systemic effects you'd experience when taking an oral or patch estrogen, but it should still help with the vaginal dryness and irritation. Be aware that even vaginal estrogen shouldn't be taken long-term.

You should also keep in mind that the issue of sexual desire is a very complicated one, and it doesn't exist only in older women but in women of all age groups. Also, a low libido actually isn't clearly related to hormonal changes — it hasn't clearly been linked to blood levels of estrogen and doesn't necessarily improve with estrogen therapy. So while hormone therapy helps with vaginal dryness and atrophy, the actual question of sex drive is a harder one to answer. These topical estrogens or the ring can indirectly help libido, though, by relieving some of the side effects of menopause and the vaginal dryness.

If your low sex drive persists, you should likely be screened for other health conditions, such as an underactive thyroid, anemia, and diabetes. Sometimes a low libido can also be related to relationship problems, and unfortunately some people just have a low sex drive.

Read more on what I have to say about regaining your sexual desire. For a more detailed discussion of this topic and more, you may find my new book Hot Flashes, Hormones & Your Health (McGraw-Hill) to be of interest. This book discusses the latest scientific evidence on the effects of hormone therapy and helps you decide which treatment is best suited to your personal health profile.

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